Apical infection spreading to adjacent teeth: a case report

Radicular cysts rarely impact the primary dentition. Apical infections in primary molar teeth accounted for the majority of cases. However, there is relatively modest data about radicular cysts related to primary incisors and its association with compound odontoma. Case Report: An 11-year-old boy presented with a history of trauma to the left upper anterior teeth region. Clinical and radiographic examinations revealed the presence of a compound odontoma associated with a radicular cyst. The cystic lesion appeared to be linked to a previously traumatized tooth. Surgical management involved the removal of the compound odontoma along with enucleation of the radicular cyst under local anaesthesia. Conclusion: Since the majority of radicular cysts of primary teeth go undetected and potentially harm the growing succedaneous tooth bud, it is critical that paediatric patients receive the proper diagnosis and treatment for better outcome of succedaneous tooth.

Regenerative endodontic procedures are designed to eliminate clinical symptoms, promote periapical healing, and restore a functional pulp–dentin complex with continued root development. However, treatment failure may occur and require retreatment. In such situations, the removal of mineral trioxide aggregate (MTA) poses a significant clinical and technical challenge. This narrative review critically appraises recent advances in MTA removal techniques following failed regenerative endodontic therapy, with particular emphasis on removal efficiency, effects on radicular dentin, and subsequent management considerations. A systematic electronic search of PubMed and Google Scholar was conducted to identify English-language articles published between 2017 and 2025 using keywords related to regenerative endodontics, MTA retrieval, chemical solvents, and assessment methods. From an initial yield of 70 articles, 10 studies met the inclusion criteria based on relevance, methodology, and scientific merit. The available evidence indicates that complete removal of set MTA from the root canal system cannot be achieved using a single technique. Mechanical methods showed limited effectiveness, while ultrasonic activation enhanced MTA retrieval but consistently left residual material. Chemical agents, particularly acidic solutions, demonstrated superior MTA softening and removal potential. However, their application was associated with reduced dentin microhardness and signs of dentinal erosion, as confirmed by micro-CT and SEM analyses. In conclusion, the findings highlight the absence of a standardized and clinically optimal protocol for MTA removal and emphasize the need for further well-designed studies to establish safe exposure times, effective concentrations, and evidence-based guidelines that balance removal efficiency with preservation of radicular dentin integrity.

Mineral trioxide aggregate (MTA) has a long history of providing predictable clinical outcomes in dental applications especially in endodontic procedures. This bibliometric analysis aimed at evaluating the advancements of research in mineral trioxide aggregate and its use in the field of dentistry, together with the detection of most significant authors, organizations, countries, journals, papers, and the exploration of commonly used keywords using a structured approach. The search was conducted using the Elsevier's Scopus database, gathering publication information related to MTA published from 1993 and 2021 July. Metadata comprising of titles, abstracts, keywords, authors, organizations, and countries were obtained. Bibliometric evaluators with respect to authors, articles published, journals, keywords, and top countries were scrutinized. Data was analyzed using VOS viewer. Between 1993 and 2021, an uptrend in the research performed on MTA was identified. Researchers from United States, Brazil, and Iran actively contributed on MTA, while papers from USA were highly cited. The Journal of Endodontics along with International Endodontic Journal were the top contributing academic journals. Hacettepe University, Turkey and Cardiff University from United Kingdom were the top most contributing organizations. Mahmoud Torabinejad was the most cited author. Most commonly used keywords included Mineral trioxide aggregate, silicate, oxide, root canal filling material. The global rise in the number of publications on mineral trioxide aggregate, tremendous networking and citations have been identified amongst various organizations, authors, and nations through this bibliometric analysis.

Mineral trioxide aggregate (MTA) is widely used for different perforation repairs, root-end filling, pulp capping and many other endodontic procedures. Because of potential discoloration effect of gray MTA, white MTA has been introduced into endodontic treatment for the same purposes. This study examined the dental pulp responses in dogs to both types of MTA used as a pulp-capping agent. The pulps of 24 teeth of four male dogs were exposed with a No.1 round bur and capped with either gray or white MTA. Histologic analysis was performed one and 2 weeks after treatment. Calcified bridge could be seen 1 week after treatment with both types of MTA, with no significant differences between the two treatments.

Surgical endodontic management of an invasive cervical resorption class 4 with mineral trioxide aggregate: A 6-year follow-up

Treatment of immature permanent teeth with blunderbuss apices and thin dentinal walls remains an enigma for endodontists. Various treatment modalities have been used to manage immature teeth, such as non vital pulp therapy with calcium hydroxide or apexification using Mineral Trioxide Aggregate (MTA), Biodentine, or bioceramic putty. However, these methods fail to address the problem of thin dentinal walls, which often leads to tooth fracture and extraction despite successful initial treatment. Regenerative Endodontic Procedures (REPs) offer the best solution for such cases, with the potential to re-establish the dentin-pulp complex, thereby facilitating apexogenesis and root maturation. The development of second-generation platelet concentrates such as Platelet-Rich Fibrin (PRF) has made the success of REPs more predictable compared to procedures that rely solely on induced intracanal bleeding. A 25-yearold female patient presented with pain and swelling in the upper anterior region, with a history of childhood trauma 17 years earlier and recent incomplete dental treatment. Clinical and radiographic examination revealed tenderness on percussion and a well-defined periapical radiolucency (~10×12 mm) involving teeth #21 and #22. Tooth #21 exhibited an open apex and a necrotic pulp, while tooth #22 had previously undergone root canal treatment. A working diagnosis of periapical pathology secondary to pulpal necrosis was made. A Regenerative Endodontic Procedure (REP) was planned for tooth #21, while tooth #22 was left untreated due to satisfactory restoration and obturation. Following disinfection using 1.5% sodium hypochlorite and placement of an interim calcium hydroxide dressing over three visits, Platelet-Rich Fibrin (PRF) prepared from autologous blood was placed as a scaffold. A collagen plug was positioned over the PRF, followed by a 3 mm layer of MTA, and the tooth was sealed with resin-modified glass ionomer cement. Follow-ups at 3, 6, 12, and 24 months revealed complete resolution of the periapical radiolucency with apical closure of tooth #21. The tooth remained asymptomatic and functional, although no response to pulp vitality tests was observed. Regenerative endodontic treatment can be successfully performed alongside conventional endodontic therapy in managing immature permanent teeth with periapical radiolucency. Two teeth involved in the same lesion can be effectively treated using different treatment modalities, and prior conventional endodontic intervention does not hinder the future success of regenerative endodontics.

Introduction. Root resorption may occur as a consequence of avulsion injury and may lead to the progressive loss of tooth structure. The aim was to report the outcome of root resorption treated with mineral trioxide aggregate in a replanted immature permanent incisor after 10 years of follow-up. Case outline. This case presents external root resorption that was detected 18 months after the avulsion injury in a nine-year-old child. Apical portion of the canal was filled with mineral trioxide aggregate and the rest of the canal was filled with a canal sealer and gutta-percha. Control examinations were performed six months after the completion of the endodontic treatment and afterwards yearly. The tooth was asymptomatic clinically and radiographs did not show progression of root resorption up to four years of follow-up. Infraposition of the injured tooth was detected five years after the replantation, but without significant radiographic changes, until the eight-year follow-up, when root resorption was detected again. However, the tooth was still hard and symptomless at the 10-year follow-up. Conclusion. Mineral trioxide aggregate may have an important role in the preservation of replanted immature teeth for a prolonged period.

Pulp necrosis in immature permanent teeth represents a challenge for clinical management. The dentin wall in immature teeth is thin and the root is short, leading to an unfavorable long-term prognosis due to the risk of root fracture. Regenerative endodontic procedures have been shown to be effective and improve the prognosis of the compromised immature tooth by re-establishing functional pulp tissue that promotes continued root development and immune competence. The objective of the study was to report a case of a young permanent molar, diagnosed with necrosis and incomplete rhizogenesis. A female patient, 08 years old, attended the clinic of the specialization course in Endodontics, Faculty of Dentistry São Leopoldo Mandic, Belo Horizonte Unit. Regenerative therapy was proposed, which involved the following steps: anesthesia, opening, odontometry, minimal instrumentation, disinfection with 2% chlorhexidine gel, irrigation with saline solution, intracanal medication with calcium hydroxide paste, induction of bleeding to form a blood clot, cervical sealing with mineral trioxide aggregate and composite resin. The patient remained symptom-free up to 5 months after treatment. However, radiographically, an increase in the periapical radiolucent area was noted, so it was decided to carry out the conventional endodontic treatment. Regenerative therapy can be an alternative to apexification in immature teeth in cases of irreversible pulpitis and pulp necrosis associated or not with a periapicalesionson. It is a simple treatment with advantageous results as it promotes an increase in the length and thickness of the dentin wall and apical closure as seen in the case described in this work.

Withing the last 10 years, the research regarding stem cell biology and tissue engineering has reaped many rewards in the field of dentistry. The goal of regenerative endodontic therapy is the regeneration of a healthy and functional pulp-dentin complex. With the development of successful materials such as mineral trioxide aggregate (MTA) and the use of the concept of tissue engineering, treating necrotic immature permanent teeth and stimulating the continuation of root-surrounding tissue formation has been made possible. Current stem cell research has also shown promising results and continues to show progress in the regeneration of dental and surrounding tissue. Since the ethical aspect of the use of stem cells is still in question, we have yet to see the potential of these materials in clinical practice. In this review, regenerative endodontic treatment prodedures, materials and developments are discussed in detail.

Background: Trauma of developing teeth may lead to pulpal necrosis with subsequent arrestment of root development, making them more susceptible to fracture. Regenerative endodontic procedures induce maturogenesis in necrotic immature permanent teeth in order to promote continuation of root growth. Mineral trioxide aggregate (MTA) is widely used as a blood clot protecting material, although it presents a potential drawback of discoloration. Biodentine is a tricalcium silicate cement with adequate bioactive properties that solve the problem of discoloration. Case report: The current case report demonstrates a maturogenesis of an upper central incisor with chronic apical abscess. Calcium hydroxide was used as intracanal medicament for a week. After a blood clot was formed, Biodentine was placed over it. Periapical healing and root growth were evident at 6 months follow-up. Cone Beam Computed Tomography (CBCT) confirmed apical closure and complete healing at 1 year. Key-learning points: Apical closure of necrotic immature permanent teeth is possible by means of regenerative endodontic procedure.Regenerative endodontic procedure with Biodentine has some advantages over that performed with MTA: No tooth discoloration, hort setting time, asy manipulation. CBCT is the best technique to evaluate root canal growth (length and wide).

Regenerative Endodontic Treatment for Necrotic Immature Permanent Teeth

Aim:The aim of the present study was to retrospectively assess the healing of periapical lesions in permanent central incisors with open apices after unintentional extrusion of mineral trioxide aggregate (MTA).Materials and Methods:The clinical and radiographic records of 75 maxillary permanent central teeth treated by MTA apexification were evaluated. Teeth with unintentionally extruded MTA formed the study group (Group 1, n = 28), whereas the teeth with no MTA extrusion formed the control group (Group 2, n = 47). For both the groups, the records were analyzed for a follow-up period of 3 years.Results:Complete healing (CH) was observed in 25 teeth in the study group, whereas all the teeth in the control group showed CH (P > 0.05). Within the study group, 6 teeth (21%) showed CH in the 6th month in Group 1, whereas in the control group, 34 teeth (72.3%) showed CH (P < 0.001). At the 1-year follow-up appointment, 19 teeth (67.8%) showed CH in Group 1, whereas 9 teeth (19.1%) showed the same result in Group 2 (P < 0.001). At the end of the 3-year follow-up period, it was noticed that in 21 (84%) teeth, extruded MTA remained unchanged, whereas it was reduced in 4 (16%) of them (P < 0.001).Conclusion:Extrusion of MTA does not have a significant effect on the healing of the periapical lesion. However, it may lead to a delay in the healing of periapical healing. Patients should be informed about the complication and consequences of extruded MTA and should be kept on follow-up to observe periapical healing.

IntroductionThe aim of this in vitro study was to determine the sealing ability of orthograde ProRoot mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM) cement as root-end filling materials.Materials and MethodsFifty four extracted single-rooted human teeth were used. The samples were randomly divided into 3 experimental groups. In group A and B, 4 mm of WMTA and CEM cement were placed in an orthograde manner and 3 mm of apices were resected after 24 hours. In group C the apical 3 mm of each root was resected and the root-end prepared with ultrasonic tips to a depth of 3 mm and subsequently, then filled with MTA. The apical sealing ability was performed with bacterial leakage method. Statistical analysis was carried out with Chi-square test.ResultsThere were no significant differences in the extent of bacterial leakage between the three experimental groups (P>0.05).ConclusionBased on the limitations of this in vitro study, we concluded that MTA and CEM cement can be placed in an orthograde manner when there is a potential need for root-end surgery.

Aim: An apicectomy is an endodontic surgical procedure which involves root‐end resection, apical curettage and root‐end filling. This article aims to discuss current guidelines and review the recent literature published on this topic. Indications and contraindications are outlined. Various aspects of the surgical procedure are discussed, including flap design, root‐end surgical management and current recommended root‐end filling materials. The expected outcomes and associated complications are also presented.Materials and methods: A targeted electronic search of PubMed and Medline databases was carried out. The keywords used in the search were ‘apicectomy, microsurgical endodontics, mineral trioxide aggregate, microsurgical instruments’. Articles from peer‐reviewed journals were included. The search was limited to articles published since 1990.Recommendations and conclusions: It is currently recommended that microsurgical techniques are incorporated in the practice of surgical endodontics. Ultrasonic tips are advised for retrograde root preparation. Amalgam is no longer recommended as a retrograde filling material. Mineral trioxide aggregate is now the material of choice. Surgical endodontics is an area where postgraduate training is advisable for those practising it.

In endodontic and restorative procedures, an accidental perforation of the pulp chamber floor or roots presents a considerablerisk, potentially leading to persistent inflammatory responses and ultimately tooth loss. Accidental root canal perforations are primary complications encountered by clinicians, requiring either surgical or non-surgical intervention, depending on the severity of the perforation. Over the years, various materials have been utilized for the treatment of such complications, but mineral trioxide aggregate (MTA) stands out prominently due to its exceptional biocompatibility, remarkable sealing capacity, and potent antibacterial properties. The unique ability of MTA to set in the presence of moisture facilitates the formation of a robust seal, thereby making it highly effective in managing root perforations and fostering tissue regeneration within the affected area. Its versatility and effectiveness have made MTA a cornerstone material in modern endodontic therapy, offering clinicians a reliable solution for enhancing the long-term prognosis of teeth affected by perforations.